The prevalence and under-reporting of financial conflicts of interest (COI) among panel members producing clinical practice guidelines on hyperlipidemia or diabetes in Canada and the USA is high, researchers report.

Indeed, the team found that over half of the current members of guideline panels and half of panel chairs had COI.

"Our data illustrate the pervasiveness of COI among members of guideline panels and may raise questions about the independence and objectivity of the guideline development process in the United States and Canada," comment the authors.

"Furthermore, our study exposes the problem of incomplete disclosure and highlights the important relation between sponsorship of guidelines and presence of COI," they add.

Jennifer Neuman (Mount Sinai School of Medicine, New York, USA) and colleagues conducted a cross-sectional study to examine the extent of financial COI, defined as the direct compensation of the guideline panelist by a manufacturer of a drug used to treat the disease of interest in the guideline, among members of guideline panels who participated in the development of 14 guidelines on hyperlipidemia and diabetes between 2000 and 2010.

The team reports that among 288 panel members, 52% (n=150) had COI, of which 138 were declared and 12 undeclared. Of those who declared conflicts, 93% reported receiving honorariums, speakers' fees, employee/adviser/consultancy payments, or stock ownership from drug manufacturers of interest. The remaining 7% reported receiving funding exclusively for research.

Of the 14 guidelines, 12 identified a chair among whom six had COI, all of which were declared.

Finally, when the researchers considered COI by guidelines' characteristics they found that panel members from government-sponsored guidelines were less likely to have COI compared with guidelines sponsored by nongovernment sources (15/92 [16%] vs 135/196 [69%]).

"Guidelines serve to standardize care, to inform evidence based practice, and ultimately to protect patients, so their freedom from bias is particularly important," comment Neuman and team. Indeed, "the Institute of Medicine recently recommended that guideline panels should be as conflict-free as possible," they say.

However, results of the present study suggest that the guideline development process "needs to be reformed to minimize conflicts of interest among panel members to ensure the credibility and evidence based nature of the clinical practice guidelines issued in the United States and Canada," conclude the authors in the BMJ.